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Govt ignores flaws in e-health push

15 Mar 2016

The Federal Government is pushing ahead with mass trials of its My Health Record e-health system despite concerns that fundamental shortcomings are yet to be addressed.

Health Minister Sussan Ley has announced that the personal health information of more than one million people will be automatically uploaded to the internet from July as part of a large-scale test of My Health Record prior to a nationwide roll-out of the scheme.

Under the plan, 700,000 people living in North Queensland Primary Health Network (PHN) and 360,000 covered by the Nepean Blue Mountains PHN in western Sydney, will have until the end of June to opt-out or have a digital health record containing details of their health status, medicines and allergies automatically created and uploaded to the system.

The trial is the latest development in the Government’s overhaul of Labor’s failed Personally Controlled Electronic Health Record (PCEHR) system, which failed to attract much support from health practitioners or patients despite the expenditure of more than $1 billion.

Ms Ley said it was important that patients be able to safely and securely share their medical records with health workers no matter where they were in the country.

“I consider this a landmark turning point in improving our health system and bringing it into the 21st century,” the Health Minister said. “Our new My Health Recordmeans people will not have to remember the names of the medications prescribed, details of diagnosis and treatments, allergies, medical procedures and there will be no need to repeat the same information when they see another doctor or go to hospital.”

The move follows a heavy-handed attempt by the Health Department to boost the adoption of My Health Record by threatening to withdraw incentive payments from practices that fail to upload shared health summaries to the system in May – action condemned by the AMA as grossly premature, particularly given the trial did not start until July.

The AMA warned that the design of the My Health Record system meant it was unlikely to realise the Minister’s vision.

The clinical usefulness of the PCEHR was fatally compromised by the ability of patients to withhold or hide information, and the peak medical body said My Health Record was similarly flawed.

Patients can set controls on who has access to information in their My Health Record, and the AMA said that, whether or not such controls were used, doctors and other health providers had to be mindful of the possibility that the information that could view was incomplete.

“Unfortunately, My Health Recordcannot be relied on as a trusted source of comprehensive information,” the AMA said. “This means that My Health Record can be a potentially useful additional source of clinical information, but it is not a replacement for existing clinical records maintained by doctors.”

The system incorporates a “break-glass option” to allow access to vital information in case of a medical emergency, but the AMA said there were many situations short of such a crisis where access to core clinical information would be valuable.

Other aspects of the system highlighted by the Minister are also likely to discourage the use of My Health Records by doctors.

Ms Ley emphasised that in designing the system the Government had paid particular attention to protecting sensitive medical information, and deliberate breaches of privacy could incur fines of up to $500,000 or even jail terms.

But the AMA said such heavy penalties were unjustified and were likely to prove counter-productive.

It said medical practitioners and practice staff already dealt with confidential information on a daily basis, and there was “nothing inherently different or unique” about the data contained in My Health Records.

Instead, it warned the complexity of the compliance rules for using My Health Records and the scale of the penalties for breaches would likely deter many practitioners from adopting them.

“While extreme penalties may appeal to those with very strong sensitivities and concerns on information access, they are counterproductive for encouraging participation by health care providers,” the AMA said. “They will be a very strong deterrent to participating in the My Health Record.”

The adoption of My Health Records is also being hampered by a failure to engage with specialists.

The AMA said medical specialists were a key group for creating and using information in electronic health records, but the Government was yet to consult with them.

AMA President Professor Brian Owler said this neglect was compounded by the fact most medical practice software was designed for GPs, not specialists.

“Until we engage with people as to how it might work, and the software vendors are on board, it’s never going to work,” Professor Owler told The Australian Financial Review.

Currently, around 2.6 million people have a digital health record, and about 8000 health providers are registered to use the system.